Georgetown University’s Walsh School of Foreign Service hosted a screening of “Thank You For Your Service,” a documentary produced by Ilan Arboleda (SFS’97) and directed by Tom Donahue, that calls attention to the failed mental health policies in the U.S. military and the consequences of those failures.
Arboleda, who was in attendance, spoke briefly before the screening, saying that during the process of making the documentary, over 250 veterans were interviewed, and the documentary would “speak for itself.” The gripping film that followed told the stories of veterans who have suffered from post-traumatic stress disorders since their time in combat, while also featuring commentary from mental health professionals and other military personnel on the administrative side of the issue.
An engaging panel discussion followed the film screening , featuring General George W. Casey, Jr. (SFS’70), Chief of Staff of the U.S. Army from April 2007 to 2011; Dr. Megan McCarthy, Deputy Director of the National Office of Suicide Prevention at the U.S. Department of Veterans Affairs (VA); and Dr. Elizabeth Stanley, Associate Professor of Security Studies at Georgetown University. The discussion was moderated by Dr. Joel Kupersmith, Director of Georgetown University Veterans Initiatives and Professor of Medicine.
The conversation centered around many of the topics touched on in the film, with the panelists contributing their own expertise and experience dealing with mental health challenges in the military.
“I think Kenny in the film [a Iraq war veteran suffering from PTSD] said it really well at the beginning [of the documentary]. He said, ‘I feel so proud of so much of what I did, and I feel ashamed of some of what I did, and how do I live with that,’” McCarthy said. “And certainly as mental health professionals, and all of us as human beings, in some kind of way, we can relate to that kind of conflict or that kind of tension, and that’s where we start.”
Lack of Preparedness
An important issue brought up both by the film and in the panel was the military’s lack of preparedness for addressing the veteran mental health crisis following the conflicts in Iraq and Afghanistan. Casey, in particular, discussed his own experience after becoming Army Chief of Staff in 2007, when he learned that the Army was severely lacking in resources aimed at suicide prevention.
“We had nothing – and this was 2007,” he said. “Nothing to prevent. And I said, ‘that’s crazy.’ We’re sending these young men and women into these hugely difficult environments, and we’ve got nothing to prepare them.”
The first time he recalls even having a discussion about post-traumatic stress was in late 2003, while he was serving as the Army Vice Chief of Staff.
“[Colonel Charles W. Hoge, M.D., an expert on physiological reactions to war,] came in and laid it out, and it was a wake-up call that the army as an institution was unprepared for what we were getting into,” Casey explained. “But you can’t just snap your fingers and create the psychologists or psychiatrists.”
Fighting the Stigma
Another obstacle towards veterans getting treatment is the stigma associated with behavioral health problems, an issue that Casey realized was essential shortly after he began his role of Army Chief of Staff in April 2007. One of the first papers he read was the annual personnel survey, which found that 90 percent of men and women in the army would not seek behavioral health care because they thought it would hurt their career.
“I knew we had post-traumatic stress problems – if we couldn’t reduce the stigma, people weren’t going to come forward to get treatment, and they weren’t gonna get better, and that was a huge problem,” he said.
Casey did note that improvement had been made over the course of his term as Chief of Staff, and that progress has continued under his successors as well.
“When I went back, right after I left, April of 2011, after four years of banging hard on the stigma, I looked at that same personnel survey,” he said. ”In April 2011 it was 50 percent of the men and women would not get behavioral health care because they thought it would hurt their career.”
While the survey did indicate a marked improvement in the willingness of soldiers to seek treatment, it was still not enough; while progress was occurring, it was occurring slowly.
“So we had 40 percent improvement,” Casey continued. “Now, as I was reaching to pat myself on the back, I realized that was still 500,000 people who wouldn’t get care.”
“Thank You For Your Service” showcases a variety of programs used to help treat veterans suffering from post-traumatic stress disorders. On the panel, Stanley discussed the program she designed which helps address these issues before reintegration into society. Called Mindfulness-Based Mind Fitness Training (MMFT, pronounced “m-fit”), the program integrates mindfulness training with body-based reregulation techniques that draws from trauma therapies. Stanley notes that MMFT demonstrated positive cognitive effects in studies done with the Marines and the Army in the mid-2000s.
“The data really show that doing particular techniques in a consistent way early on can really rewire the body and mind,” Stanley explained.
Still, the program has not expanded, some citing concerns with the time commitment required to properly implement it. In order to be effective, Stanley notes, the mindfulness training should be incorporated as part of a daily regimen.
“There is going to be no quick fix. There really is going to have to be a commitment… it has to be a core piece of how one conceptualizes being a warrior,” Stanley said.
“We tried to make mental fitness part of being a good soldier,” he explained.
McCarthy discussed the data report released by the VA Office for Suicide Prevention in August 2016, the most comprehensive analysis of veteran suicide rates in the United States.
Among other statistics McCarthy cited, the report found that an average of 20 veterans a day die from suicide, and that veterans have a 21 percent increased risk of suicide compared to the civilian population. Female veterans face a staggering 240 percent higher risk of suicide compared to their civilian counterparts.
While McCarthy said that the exact reasons for these heightened suicide rates are unclear, there are a multitude of theories. One of them is that female veterans have an increased access to firearms over civilian women. She explained that the suicide impulse often arises quickly, making access to lethal means a critical component.
“If we can build time and space in between the impulse to hurt oneself and the means to do it, we’re gonna end up saving a lot of lives,” McCarthy said.
With an increasing public awareness of mental health care challenges facing the military, military personnel and mental health professionals are working to continue the slow yet steady progress that has been made.
People are anxious to see how the new administration will address these issues. For example, one Navy veteran in the audience expressed his concern that modifying or reducing the Affordable Care Act might cause veterans who have had their health care subsidized through another source will now turn to the VA in larger numbers. Such a move, he worried, would have negative implications, especially when coupled with the federal hiring freeze that would prevent the VA from adding additional personnel to address the influx of patients.
“It’s certainly a possibility that the upcoming changes in the way healthcare is structured in this country that more veterans will be coming to the VA for healthcare,” McCarthy responded. “And that’s absolutely something we’re planning for in the VA. And as I think we’ve all been talking about, [we’re] learning to think creatively about how to solve these problems without compromising quality of care.”
In his closing remarks, Casey emphasized the importance of solidifying the steps that have been taken so far. He stressed the need to work together as a country, a Defense department, and a Veterans Affairs department committed to serving those who served.
“We have to institutionalize what we have learned in the past fifteen years – and we’ve been off to a very slow start,” Casey said. “But we’ve learned so much that if we do what we’ve done after every war and forget, then we’ve really lost.”